If you are searching Medicare Advantage Plans in South Carolina, PlanPrescriber can be your resource for information and plan comparisons.

How Medicare Advantage works in South Carolina

The U.S. government requires Medicare Advantage plans in South Carolina, as in every state, to offer at least the same coverage as Original Medicare, Part A (hospital insurance) and Part B (medical insurance), with the exception of hospice care which remains covered under Part A benefits. In addition, many Medicare Advantage plans have more extensive coverage, offering extra benefits like routine vision care. Many plans also offer prescription drug coverage.

To sign up for a Medicare Advantage plan, you must have Original Medicare, Part A and Part B and select a plan that serves the community where you live.

You can enroll in a Medicare Advantage plan during your Initial Coverage Election Period (ICEP). The Initial Coverage Election Period usually occurs simultaneously with the Initial Enrollment Period for Original Medicare, which begins three months before the month you reach age 65, includes your birthday month, and ends three months after that month.

If you didn’t enroll in a Medicare Advantage plan when you were first eligible, or if you want to switch Medicare Advantage plans or make certain other coverage changes, you can take advantage of the Open Enrollment Period for Medicare Advantage and Prescription Drug coverage Period, which runs from October 15 to December 7 each year. This is also known as the Annual Election Period. Your new coverage goes into effect on January 1 of the following year.

In certain situations, you may be allowed to switch Medicare Advantage plans in South Carolina (as in other states) during a Special Election Period. Those situations include, but are not limited to: moving to a new address where your existing plan isn’t available; losing your current coverage, or experiencing changes in your current plan that affect your health benefits. Special Election Periods vary depending on personal circumstances that might affect your ability to receive Medicare benefits to which you are entitled if you were not permitted to make a change to your Medicare Advantage plan when the circumstance arose.

If you’re enrolled in a Medicare Advantage plan in South Carolina and want to switch to a different Medicare Advantage plan, you may do so during the  Medicare Advantage Open Enrollment Period, which runs from January 1 to March 31. During this period, you can also drop your Medicare Advantage plan and go back to Original Medicare, Part A and Part B. Then, if you wish, you can add a stand-alone Medicare Part D Prescription Drug Plan to go alongside your Original Medicare.

If you decide to enroll in a Medicare Advantage plan in South Carolina, you have to keep Medicare Part A and Part B, and you have to continue paying your Medicare Part B premium.

Types of Medicare Advantage plans in South Carolina

You will probably want to familiarize yourself with the various types of Medicare Advantage plans available in South Carolina so that you can make an informed decision about this alternative way to receive your Medicare benefits. The main types of Medicare Advantage plans are described below.

  • A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that generally requires you to visit doctors, health-care providers, and hospitals in your plan’s network to receive benefits from the plan except in the instances of emergency care or medically necessary care that is authorized by the plan and not available within the plan’s network.
  • An HMO Point-of-Service plan is more flexible than a standard HMO plan, which sometimes allows you to go out of network for covered health services, but generally at a higher out-of-pocket cost.
  • A Preferred Provider Organization (PPO)* plan offers even greater flexibility, allowing you to select doctors, health care providers, and hospitals outside your plan’s network, but again at a higher out-of-pocket cost.
  • A Private Fee-for-Service (PFFS) plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense. Any provider you use must agree to accept the plan’s terms and conditions on a case-by-case scenario and agree to treat you. The PFFS plan may offer a partial or full network of providers, and sometimes does not involve any networks at all. It is important to check with the provider to see if they accept the plan because not all providers accept it.
  • A Medical Savings Account (MSA) plan combines a high deductible with a savings account into which Medicare deposits money that you can use to pay for your health-care expenses.
  • A Medicare Special Needs Plan (SNP) is for people with certain health needs, offering coverage tailored to suit their specific situations. There are Medicare SNPs for people with chronic conditions, those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
  • A Medicare Advantage Prescription Drug (MAPD) plan combines health and prescription drug coverage into a single insurance plan.

Compare South Carolina Medicare Advantage Plans

It is important to compare your plan options when selecting a Medicare Advantage plan in South Carolina. The availability and cost of Medicare Advantage plans varies. Some Medicare Advantage plans in South Carolina may offer premiums as low as $0. Out-of-pocket costs such as deductibles, copayments and coinsurance may vary among plans as well. Also the maximum out-of-pocket medical expense you pay during the benefit year before your plan pays 100% of covered medical services may vary. (Original Medicare does not have this out-of-pocket limit to your annual medical expenses for covered services.)  Medicare Advantage plans with provider networks may set different maximum out-of-pocket limits for medical expenses incurred from in-network providers and out-of-network providers.

You should also decide whether or not you want prescription drug coverage with your Medicare Advantage plan (Medicare Advantage Prescription Drug plan). Remember that Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare coverage. Hence, plan comparisons can yield some valuable information to help you choose the Medicare Advantage plan that has benefits best suited to your needs and preferences.

Most Medicare Advantage plans include a network of participating health-care providers. You generally pay less out-of-pocket when you receive covered services from a physician, hospital or other health-care professional participating in the network. Therefore, you are encouraged to review the list of participating providers before you enroll to see if doctors and hospitals you use are participating in the Medicare Advantage plan.  Typically you review Medicare Advantage plans’ provider directories or search for a provider by name, specialty and address online, or you can call the Medicare Advantage plan’s Customer Service if you prefer.

You may refer to the articles listed below for more information about Medicare in South Carolina:

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.